Complaint form
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Addressee:
[seller’s identification details]
COMPLAINT FORM
CUSTOMER DATA:
First name and last name: ………………………………………………………………..
Address: …………………………………………………………………………………………….
E-mail: ………………………………………………………………………………………………
Tel .: ………………………………………………………………………………………………….
Bank account number: ……………………………………………………………………..
SUBJECT OF COMPLAINTS:
Product purchase date: …………………………………………………………………………
Product name: ……………………………………………………………………………………..
Invoice number: …………………………………………………………………………………..
The total value of the product: ………………………… PLN/EURO
DECLARATION OF COMPLAINTS (description of defects and circumstances of their creation):
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When the defects were found ……………………………………………………………………………………………………
REPAIR ACTIONS / REQUESTING CLAIM:
(___) exchange of things for free from defects,
(___) removing the defect,
(___) price reduction,
(___) withdrawal from the contract.
………………………………………………… ..
Signature
SELLER NOTICE – DECISION CONCERNING COMPLAINTS
The complaint has been recognized / not recognized for the following reasons:
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Date of receipt of the complaint ……………………………….
The person considering the complaint ……………………………….
Date of consideration of the complaint ……………………………….
Further complaint proceedings – information for the client
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